Last month, surgeons from Johns Hopkins University published a small case series in detailing their success in restoring smiles to patients with facial paralysis. In this video, lead author Kofi Boahene, MD, of Johns Hopkins University School of Medicine in Baltimore, describes the unique surgical procedure they used, and highlights what physicians who treat patients with facial paralysis need to know in order to increase the chance of restoring movement with Hopkins' novel technique.
Following is a transcript of his remarks:
Recently we published our work on a new technique that we've developed to try to restore animation to patients whose faces are paralyzed. What I mean by that -- for various reasons, somebody can wake up one day and they've lost their ability to close their eyes, smile. When they eat, they drool. They can't breathe. Most commonly that's called Bell's palsy, but there are some people who are born and never have the ability to move. They can't smile. They can't express emotions with their face. They cannot communicate non-verbally. And there are other people who, as a result of a cancer or a tumor -- a common one being an acoustic neuroma -- will have surgery, and then the facial nerves are injured. Going into surgery, their faces move normally, but they wake up and they can't move their faces. They can't smile. They can't blink.
You can imagine what trauma this can be to a person, so we've dedicated our research and our clinical work to try to restore faces that move, work, and express themselves when such unfortunate issues happen.
We worked on a technique called a multivector gracilis flap. The multivector gracilis flap is a technique of moving muscle that normally exists in the thigh, and then technically teasing that muscle up into multiple fascicles, and then trying to use that muscle to replace a lot of the muscles that are paralyzed in the face.
Our goal is to not just restore some form of movement to the face, but really to be able to allow the person to express joy. When they smile, their eye is squinting. When they smile, their lips move, the corners of their mouth move, you can see their teeth. And then really, it becomes a spontaneous thing that elicits a response from the people who are observing. We've had very good response for the first series of patients which we've done, and we think there are a lot of patients that can benefit from this technique.
We have a comprehensive approach to looking at the face that is not moving or is paralyzed. It's very common for me to hear on a weekly basis someone who has had his face paralyzed for years, and then they'll come to tell us, "We read this story about a new technique. We never thought anything could be done for us because I've had this problem all my life." That's the message we want to send out -- to patients and to physicians -- that any kind of paralysis in the face, there's actually something that can be done. We never want patients to walk around without the hope that something can be done.
The techniques we have sometimes are as simple as rearranging muscles in the face. Sometimes it's just moving one from one place and repurposing, and other times we will be going somewhere else in the body to move muscles as the multivector gracilis flap is. For every kind of facial paralysis, we do have an option.
There are patients who have suffered from Bell's palsy. Bell's palsy is probably one of the most common reasons that people get paralysis of the face. You wake up one day, face doesn't move. The majority of patients with Bell's palsy tend to recover, and so people take it for granted. They would see a physician, they would get steroids, they would get antiviral medications, and they'd be told, "You're probably going to recover." We see them a year and a half later, and their faces are frozen. They can't move their faces very well. They waited too long.
The second message and the point we want to make clear to physicians is never tell a patient that their face is going to recover and then don't see them back frequently. They should be seen early enough because when we intervene early, we can do simple things to restore their faces. So two points: (1) Never tell a patient that there's nothing that can be done; and (2) Don't hold on to patients too long, because the sooner we see them, the better we can intervene.
One way to summarize this is that as far as the face is concerned, time is muscle. The longer you wait, the more muscle you lose and the more complicated the solutions will be.